Medical Residents Can Work 24 Hours Straight

A group that accredits medical residency programs is lifting caps on work hours of first-year doctors-in-training, saying young residents aren’t harming patient care by working 24 consecutive hours plus another four to transition their patients to another provider.

The announcement Friday by the Accreditation Council for Graduate Medical Education (ACGME) makes final a set of revisions to residency professional standards. The new requirements take effect July 1 of this year.

The move comes after some doctor groups and physician educators questioned whether capping first-year resident work hours at 16, which was implemented in 2011, improved patient safety and may have instead contributed to other medical errors when the care is handed off more frequently to other health professionals.

But the ACGME, which implements such rules for doctor training programs, says capping first-year resident work hours to shorter shifts was restrictive and could hurt patient care and the quality of doctor training.

“At the heart of the new requirements is the philosophy that residency education must occur in a learning and working environment that fosters excellence in the safety and quality of care of care delivered to patients both today and in the future,” Dr. Tomas Nasca, ACGME’s chief executive officer, wrote in a memo to the graduate medical education community.

The final revisions to standards come after more than 14 months of review and debate, particularly among surgeons who felt capping hours at 16 was unrealistic. Neurosurgeons and other medical disciplines said it’s not uncommon for a patient’s injury or illness to require a physician to perform surgery followed by post-operative care that can last well beyond 16 hours.

“The long shifts are infrequent, but they are important when needed,” ACGME task force member Dr. Anai Kothari, a third-year general surgery resident at Loyola University Medical Center, in the western Chicago suburb of Maywood, said in an interview.

Patients want to know “you are the doctor taking care of them” from before the surgery when it is explained until after it’s completed. “Potentially, you would not be allowed to talk to the family after [a patient’s surgery]” if the 16-hour cap wasn’t lifted, Kothari said. “The new standards allow for flexibility to do those things.”

ACGME said “core elements” from earlier changes to its standards from 2003 and 2011 requirements have been preserved that limit residents to a maximum of 80 hours per week. Doctors-in-training also have “one day free from clinical experience or education in seven.”

The council cited research conducted over the last five years that confirmed an 80-hour cap was a good balance between “simulating real-world experiences residents” may encounter with a first-year resident’s “ability to be properly rested.”

The 80-hour weekly cap was first adopted by the state of New York, and ACGME adopted the same standard in 2003.

“The duty hour recommendations are consistent with a learning environment that maximizes experiences, offers consistency with other learners and allows trainees to be part of interprofessional teams that are treating patients,” said Dr. Darrell Kirch, CEO of the Association of American Medical Colleges.

ACGME in 2011 imposed stricter work hours for residents including a 16-consecutive-hour cap on shifts that could be worked by first-year medical residents.

There were also certain requirements regarding time off between shifts. At the time, reports said long hours contributed to medical errors and the council and graduate medical education programs across the country were under pressure from myriad forces including Congress to do something about it.

Some physician groups and public health advocates say the council’s move lifting the 16-consecutive-hour cap puts first-year residents, patients and the public at risk. “The ACGME’s adoption of this dangerous proposal displays a reckless disregard for the lives and health of thousands of medical residents and their patients nationwide,” Dr. Michael Carome, Public Citizen’s Health Research Group director said in a statement Friday.

But ACGME task force members said the recommendations have overwhelming support in the healthcare community. ACGME received testimony at various meetings from more than 60 groups and medical educators and related written statements from more than 110 medical organizations.

“We tried to make these evidence-based,” Dr. Rowen Zetterman, ACGME board chair and professor at the University of Nebraska Medical Center, said in an interview.

“We reviewed more than 1,000 articles on duty hours and the learning and working environment. We are looking at the culture of training rather than the exact hours.”

Summary: A group that accredits medical residency programs is lifting caps on work hours of first-year doctors-in-training, saying young residents aren’t harming patient care by working 24 consecutive hours plus another four to transition their patients to another provider.

The announcement Friday by the Accreditation Council for Graduate Medical Education (ACGME) makes final a set of revisions to residency professional standards. The new requirements take effect July 1 of this year.

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